左西孟旦在重症冠状动脉旁路移植患者术后的作用研究

摘要

目的 评价危重冠心病患者术后应用左西孟旦的效果差异. 方法 选取泰达国际心血管病医院及中国医科大学第一附属医院心脏外科2013年5月至2016年6月期间收治的危重冠状动脉旁路移植患者485例,其中45例术后应用左西孟旦,根据倾向性评分对比匹配法找出最匹配的45例进行对比研究,两组术前临床资料无差异(P＞0.10),比较术后转归情况. 结果 两组患者术后48 h,心率、平均动脉压、中心静脉压、心排血量等血流动力学指标变化明显.心脏超声结果提示48 h后,应用左西孟旦组左心室射血分数(LVEF)较对照组升高[(0.53±0.12)％和(0.46±0.09)％,t=2.594,P=0.002];术后呼吸机应用时间[(46.8±11.3)h和(58.5±16.3)h,f=-2.031,P=0.045]、肠鸣音出现时间[(16.5±5.9)h和(18.7±10.1)h,f=1.592,P=0.039]、新发急性肾损伤(AKI)(20％和40％,x2 =6.702,P=0.018)、新发房颤(15.6％和44.4％,x2=6.156,P=0.023)及围术期心肌梗死(11.1％和33.3％,x2 =6.429,P=0.021)发生有明显区别,但ICU滞留时间、术后1个月内死亡率、恶性心律失常发生及辅助器械应用差异无统计学意义(P＞0.05). 结论 左西孟旦可以改善危重冠状动脉旁路移植术后患者早期预后,减少术后脏器功能损伤发生.%Objective To evaluate the effect of Levosimendan on the prognosis in patients with severe coronary heart disease after operation.Methods A total of 485 severe coronary disease patients undergoing coronary artery bypass grafting from Teda International Cardiovascular Hospital and the Cardiac Surgery Department of the First Affiliated Hospital of China Medical University from May 2014 to June 2016 were enrolled.Of them,45 cases receiving Levosimendan postoperatively were assigned to the Levosimendan group,and according to propensity score matching,another 45 cases were selected as the control group in this study.Clinical data before treatment had no difference between the groups (P ＞ 0.1).Postoperative prognosis was compared between the two groups.Results There were significant differences in heart rate,mean arterial pressure,central venous pressure,cardiac output and other hemodynamic parameters between the two groups 48h after operation.The heart ultrasound results showed that the left ventricular ejection fraction(IVEF) was increased [(0.53±0.12) ％vs.(0.46±0.09)％,t =2.594,P=0.002],the postoperative ventilation time was reduced [(46.8±11.3) h vs.(58.5±16.3) h,t=-2.031,P=0.045]and the onset of bowel sounds became early [(16.5±5.9) h vs.(18.7±10.1) h,t =1.592,P=0.039]in the levosimendan group than in the control group 48h after operation.The incidences of new-onset acute kidney injury(20 ％ and 40 ％,x2 =6.702,P =0.018),new-onset postoperative atrial fibrillation (15.6％ and 44.4％,x2 =6.156,P =0.023) and perioperative myocardial infarction(11.1 ％ and 33.3％,x2 =6.429,P =0.021) had significant differences between the two groups(P＜0.05),but there was no difference in ICU retention time,1-month mortality after operation,malignant arrhythmia incidence and auxiliary equipment use (P ＞ 0.05).Conclusions Levosimendan can improve the early prognosis of severe coronary disease patients undergoing coronary artery bypass grafting and reduce the occurrence of postoperative organ dysfunction.